Once Upon A Time

AUTHOR'S NOTE: I am very frustrated with a system that increases cost dramatically and yet reduces what I get paid. The rest of the money is going somewhere, and since it is not improving the overall quality of care, it is mostly waste. We are enamored with MRI scans, stents, and expensive cancer treatments, with little to show for them except increased expenses and a lot of third parties getting rich off of this waste: drug and device manufacturers, medical imaging companies and other para-healthcare industries. This story, which originally appeared at Musings of Distractible Mind, is prompted by my frustration with waste and how it spurs unneeded health care delivery.

Once upon a time there was a land on the ocean. The people lived off of the food from the ocean and were very happy. But as they grew bigger, they had a problem: They made a lot of waste! Yuk! Nobody likes waste. What could they do about all of this that stuff that nobody needed?

Some said that they should find a way to make less waste. They said that the people of the land were not smart and should be making less waste. But most of the people in the land didn't like to change what they were doing. It's hard to change. So they built a large pipe that pumped the waste into the ocean.

The land was clean again and the people were happy!

As time went on, they had to build more and more pipes to handle their waste. Nobody ever tried to make less waste because they could just make more pipes and pump it into the ocean. This even built a very successful industry of pipe-workers. This helped the economy.

But then one day something terrible happened. The pipes pumping waste killed off several species of sea life. This made the environmentalists in the land cry out in protest. But as it stood, the number of species in the ocean were so vast that the killing off of a few of them was felt to be no harm. So the pipes kept pumping. The people still could be happy with a few less species.

And then came a day when something magical happened. New species of sea creatures formed around the pipes. These creatures fed off of the waste and thrived around these pipes. These new creatures became very big and very fancy, and this made the people of the land very happy. What were the environmentalists all worried about? So what if a few species had died off; there were new exciting species being formed! The people were so excited that they made even more waste and more pipes so they could make more new species of sea creatures.

What fun!

Now, these fancy new creatures were hungry. They ate all of the waste and wanted more. They ate most of the other sea animals and wanted still more. They couldn't get enough food. So they sent lobbyists to the government of the land to get them to build more pipes and send more waste. The creature lobby was very rich, and so poured lots of money at the government of the land. This made the politicians very happy. So the happy politicians told the companies of the land to make more pipes and send more waste out to the sea. And the sea creatures were happy.

And so it went for many years: more pipes sending more waste making more fancy sea creatures eating more waste sending more lobbyists to make politicians get more companies in the land to build more pipes. Everyone seemed to benefit from this nice arrangement! Maybe they'd be happy forever!

But one day, some of the people of the land got tired of putting all of their money into building pipes to send waste. They thought their land should stop making so much waste and start putting those resources into schools, food and fighting crime. The government was raising taxes more and more so that they could afford to make more pipes. This made these people mad because some people couldn't afford any more taxes. Paying for all of this waste was too much.

But the lobbyists from the sea creatures put commercials on television saying how good the waste was. In fact, having so much waste made the land one of the best lands anywhere. They pointed out how many new sea creatures came to be because of this waste and how other lands couldn't do this. The pipe manufacturers also made commercials telling about all of the jobs these pipes were creating. They all made so much sense!

They also sent more money to the politicians so they would ignore the people who couldn't afford paying for the waste.

But then some of the people of the land ran out of money and stopped paying taxes. This made the government mad, and so it left these bad people to live in their own waste. Many of these people became sick in their waste, and some of them died. Finally, the cry of the people was loud enough that the politicians in the land took notice. They decided that all of this waste was a real problem. No other land had so many pipes sending so much waste. True, there were lots of fancy new sea creatures, but the people in the land were getting angry, and some were dying.

But the politicians started fighting. One group of the politicians decided that the pipe-making companies were the problem. They thought that the government should take over the pipe-making job and guarantee waste pipes for every home. Others thought that the government could never do as good of a job as the companies did. They said that those people who couldn't afford pipes were dead-beats and probably deserved to die.

They held town hall meetings to talk about who should be making pipes, and people got very angry.

Finally, someone who wrote a waste-pipe blog suggested that perhaps the problem wasn't the pipes, but instead it was the waste. He said that the people should find a way to cut back on the waste, and so need fewer pipes. The blogger was criticized sternly, because his suggestion would have very bad consequences. The new fancy sea creatures that made everyone so proud would die off if they cut back on waste, and the pipe-workers would lose their jobs and be very sad. Plus, people didn't want the government telling them how much waste they could make. It's a free country, and people should be able to make waste without the government rationing it.

But as the people of the land thought about what this blogger said, they saw the sense in it. Yes, the sea creatures and the pipe manufacturing companies put very moving commercials on TV about dying sea creatures and unemployed pipe workers. They were very sad commercials and they made a lot of people weep. But the people of the land realized that this land was for people to live in, not for pipe companies or fancy sea creatures. Yes, it would be sad to not have those fancy creatures, and they'd have to get new jobs for the pipe company workers, but it was the only way.

Oh, it was hard to cut back on waste and kill off the fancy sea creatures. People got very mad and lobbyist groups tried to change laws or pay off politicians. But this was a good and smart kingdom, and they didn't listen to the creatures any more. And finally the day came when the sea was clean again.

And everyone was happy.

Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.

Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.
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